» Drug, Devices, and Supplements

» Physician Accountability

» Consumer Product Safety

» Worker Safety

» Health Care Delivery

» Auto and Truck Safety

» Global Access to Medicines

» Infant Formula Marketing


More Information on Quality of Care

Guide to Avoiding Unnecessary Cesarean Sections in New York State

April 21, 2010

Sidney Wolfe, M.D.
Public Citizen Health Research Group

Full report as a pdf
Statements from press conference

About New York
Variations in Cesarean Sections, VBACs, and Midwife Availability by County and by Hospital Within Each County
Healthy Outliers: Two New York Hospitals that Have Bucked the Trend
Factors Possibly Associated with Variation in Rates
What is Driving Cesareans in New York?
How a Woman Can Avoid an Unnecessary Cesarean in New York State
What Health Departments and Hospitals Can Do to Reduce Unnecessary Cesareans
New York Hospital Birth Statistics by County

About New York

The fact that few states routinely publish statistics on cesarean sections performed in their hospitals limits national studies based on routinely collected data. Indeed, New York is one of only two states that provide intervention rates for all obstetric procedures at the facility level.[1] 

We have chosen to look at the data for New York State to examine how cesarean sections vary by different factors associated with health care delivery. While New York’s transparency with respect to maternity data makes it an outlier in terms of the rest of the nation, the state nevertheless serves as a model for other states. Moreover, in addition to maintaining updated hospital-specific data that are easily retrievable, New York offers the following advantages:

  1. New York has over 200 hospitals, most of which provide maternity services. This sample is large enough to provide information on rates by level of care and size of hospital.
  2. The state has a large population, with ethnic and racial diversity, urban and rural residents, and a full range of hospital types, from small facilities with a limited catchment area to major medical centers serving a statewide, national, and even international population. It can therefore reflect conditions for the nation as a whole.
  3. The state is a leader in medical education and has a disproportionate share of medical schools and graduate training programs. For this reason, New York can be considered a bellwether in the use of technology and the adoption and diffusion of medical practices. 

New York has a regionalized system of perinatal care which classifies maternity services into four levels and stratifies risks accordingly.[2] Each region is headed by a Regional Perinatal Center (RPC) that provides the full range of services required for high-risk women and newborns. Other hospitals in each area are classified as follows:

  • Level 1 hospitals provide care to normal and low-risk pregnant women and newborns, and they do not operate neonatal intensive care units (NICU);
  • Level 2 hospitals provide care to women and newborns at moderate risk and do operate NICUs;
  • Level 3 hospitals care for patients requiring increasingly complex care and operate NICUs.[3]

The perinatal hierarchy of care is predicated on hospitals being explicitly differentiated by level of expertise and technology. This facilitates matching medical needs and resources by referring patients with potential maternal and fetal problems to facilities in which they can get appropriate care.

New York State has a higher cesarean rate than the country as a whole: 33.7 percent vs. 31.8 percent. According to data from 2007, the rate in New York is exceeded by only nine states.[4] At the same time, New York has a higher rate of VBACs: 9.3 percent, compared to 8.0 percent for the country as a whole.

[1] "About the Project." The Birth Survey. Web. <>.

[2] “Glossary: Perinatal Center." New York State Department of Health. Web. <>.

[3] Ibid.

[4] Menacker F, Hamilton BE. Recent Trends in Cesarean Delivery in the United States. NCHS Data Brief, No 35. Hyattsville, MD: National Center for Health Statistics. March, 2010.

Copyright © 2016 Public Citizen. Some rights reserved. Non-commercial use of text and images in which Public Citizen holds the copyright is permitted, with attribution, under the terms and conditions of a Creative Commons License. This Web site is shared by Public Citizen Inc. and Public Citizen Foundation. Learn More about the distinction between these two components of Public Citizen.

Public Citizen, Inc. and Public Citizen Foundation


Together, two separate corporate entities called Public Citizen, Inc. and Public Citizen Foundation, Inc., form Public Citizen. Both entities are part of the same overall organization, and this Web site refers to the two organizations collectively as Public Citizen.

Although the work of the two components overlaps, some activities are done by one component and not the other. The primary distinction is with respect to lobbying activity. Public Citizen, Inc., an IRS § 501(c)(4) entity, lobbies Congress to advance Public Citizen’s mission of protecting public health and safety, advancing government transparency, and urging corporate accountability. Public Citizen Foundation, however, is an IRS § 501(c)(3) organization. Accordingly, its ability to engage in lobbying is limited by federal law, but it may receive donations that are tax-deductible by the contributor. Public Citizen Inc. does most of the lobbying activity discussed on the Public Citizen Web site. Public Citizen Foundation performs most of the litigation and education activities discussed on the Web site.

You may make a contribution to Public Citizen, Inc., Public Citizen Foundation, or both. Contributions to both organizations are used to support our public interest work. However, each Public Citizen component will use only the funds contributed directly to it to carry out the activities it conducts as part of Public Citizen’s mission. Only gifts to the Foundation are tax-deductible. Individuals who want to join Public Citizen should make a contribution to Public Citizen, Inc., which will not be tax deductible.


To become a member of Public Citizen, click here.
To become a member and make an additional tax-deductible donation to Public Citizen Foundation, click here.